Bone marrow transplantation in malignant lymphoma. Report of a workshop at the third international conference in lymphoma at Lugano, Switzerland, June 1987
✍ Scribed by Professor G. P. Canellos; Dr J. Armitage; Dr P. Ernst; Dr A. Gianni; Dr A. H. Goldstone; Dr N. C. Gorin; Dr T. Philip; Dr G. Santini; Dr T. Takvorian
- Book ID
- 102255023
- Publisher
- John Wiley and Sons
- Year
- 2006
- Tongue
- English
- Weight
- 306 KB
- Volume
- 5
- Category
- Article
- ISSN
- 0278-0232
No coin nor oath required. For personal study only.
✦ Synopsis
In the last five years, there has been an expanded experience in the use of autologous bone marrow reinfusion with high doses of chemotherapeutic agents alone or combined with whole body radiation. In most instances, this is used in the setting of refractoriness or relapse from standard doses of chemotherapeutic agents. The majority of patients have some form of non-Hodgkin's lymphoma, although the experience in Hodgkin's disease is increasing.
The rationale is based on (1) the known sensivitity of the malignant lymphomas to the cytotoxic action of cancer chemotherapeutic drugs and radiation even in relapse, (2) the demonstrated steep dose-response curve of the agents for these turnours, and (3) that myelosuppression is the limiting toxicity of the agents. The same rationale was the basis for its use in leukemia therapy.
During the Third International Conference on Lymphoma, held in Lugano, Switzerland from June 10-13,1987, a workshop was held on the current status of bone marrow transplantation and high dose therapy in lymphoma. The workshop included presentations on autologous and allogeneic transplantation in non-Hodgkin's lymphoma, autologous transplantation in Hodgkin's disease and lymphoblastic lymphoma.
Dr J. Armitage (University of Nebraska, Omaha, Nebraska) reviewed multiple series, including his own data on the use of high doses of cyclophosphamide (6.0 g/m2). BCNU (300 mg/m2), and etoposide (VP-16) (750 mg/mz) with autologous marrow reinfusion for Hodgkin's disease in relapse or refractory to conventional therapy. The 'CBV' regimen originally developed at M.D. Anderson Hospital was given to the majority of 195 cases resulting in a 51 per cent complete remission rate. As this was a pilot experience in patients with variable degrees of prior therapy and general medical status, 12 per cent died of toxicity attributed to the therapy. With still a relatively short follow-up of two to four years, about 1/3 remain alive and free of disease. The likelihood of response was related to (1) the number of prior chemotherapy regimens, (2) performance status, (3) the bulk and extent of disease, and (4) tumour response to the conditioning regimen itself. All of the partial responders were dead by 30 months. Reference was made to the higher response rate (76 per cent) achievable by even higher doses of CBV (7.2 g/mz, 600 mg/mz, 2400 mg/m2) in another series, but an increased toxic death rate was also noted. Another explanation for the higher response rate (Vancouver study) is the fact that the majority of patients were in relapse oftherapy rather than refractory to therapy. The issue of long-term 'salvage' of advanced Hodgkin's disease in relapse from initial chemotherapy is somewhat controversial given the poor results with ABVD in most series, especially if relapse occurs within one year of cessation of chemotherapy. Late relapse from primary therapy in some instances may be successfully treated with repeat of the